PROJECT PARTNERING CHECKLIST_



NORTHWEST REGION STRUCTURE BENCHMARK LOCATION CHECKLISTPROJECT ID: FORMTEXT ?????FEDERAL ID: FORMTEXT ?????CONTRACT ID: FORMTEXT ?????COUNTY: FORMDROPDOWN HIGHWAY: FORMTEXT ?????NAME OF ROAD: FORMTEXT ?????TYPE OF WORK: FORMTEXT ?????PROJECT LEADER: FORMTEXT ????? FORMTEXT ?????PROJECT MANAGER: FORMTEXT ?????PROJECT SUPERVISOR: FORMTEXT ?????CONTRACTOR: FORMTEXT ?????LETTING DATE: FORMTEXT ?????DATE FORM COMPLETED: FORMTEXT ?????THIS FORM IS TO BE COMPLETED AND SUBMITTED TO THE REGION SURVEY COORDINATOR.(Please attach a county map with the structure locations circled in red.)Structure Number:B- FORMTEXT ?????- FORMTEXT ?????orC- FORMTEXT ?????- FORMTEXT ?????Year Set: FORMTEXT ?????Set By: FORMTEXT ?????Elevation: FORMTEXT ????? FORMCHECKBOX Metric FORMCHECKBOX English(Check one)ELEVATIONS ARE BASED ON NATIONAL VERTICAL DATUM OF 1929Description: FORMCHECKBOX Aluminum Disk or FORMCHECKBOX Brass Disk or FORMCHECKBOX Chiseled Square(Check one)Location: FORMCHECKBOX Parapet or FORMCHECKBOX Deck or FORMCHECKBOX Abutment or FORMCHECKBOX Other: FORMTEXT ?????(Check one) FORMCHECKBOX NE or FORMCHECKBOX NW or FORMCHECKBOX SE or FORMCHECKBOX SW Corner of Structure(Check one)Type Of Placque: FORMCHECKBOX WISDOT or FORMCHECKBOX USGS or FORMCHECKBOX NGS or FORMCHECKBOX Other: FORMTEXT ????? (Check one)Map Location: FORMTEXT ?????(Distance from nearest major intersection)Feature Crossed: FORMTEXT ?????(Stream, Highway, etc.)Please list all bench marks that were destroyed during construction: (Only list those that were included on the plan and profile sheets.)NO.STATIONDESCRIPTIONELEVATION FORMTEXT ????? FORMTEXT ????? FORMTEXT ????? FORMTEXT ????? FORMTEXT ????? FORMTEXT ????? FORMTEXT ????? FORMTEXT ????? FORMTEXT ????? FORMTEXT ????? FORMTEXT ????? FORMTEXT ????? FORMTEXT ????? FORMTEXT ????? FORMTEXT ????? FORMTEXT ????? FORMTEXT ????? FORMTEXT ????? FORMTEXT ????? FORMTEXT ?????Use the back of this sheet for additional comments. ................
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